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The HUD 52665 form is an essential document used within the Housing Choice Voucher Program, specifically designed to manage family portability transfers between different Public Housing Agencies (PHAs). Primarily, this form facilitates the transition for families moving out of their initial PHA's jurisdiction and ensures that necessary data is standardized and accurately shared with the receiving PHA. It collects critical information, including the head of household’s name, social security number, and details about their housing situation such as voucher numbers and bedroom sizes. The form also encompasses important financial details necessary for billing processes between the two PHAs, which may include administrative fee rates and annual income information. Sensitive data compiled on this form is safeguarded under the Privacy Act, ensuring that the information remains confidential and secure. By outlining the parameters for portability and billing, the HUD 52665 streamlines the administrative functions involved in housing assistance, thereby supporting families in their housing journeys and promoting efficient inter-agency communication.

Hud 52665 Example

Family Portability Information

U.S. Department of Housing

OMB Approval No. 2577-0169

Housing Choice Voucher Program

and Urban Development

(exp. 04/30/2018)

Office of Public and Indian Housing

 

Public reporting burden for this collection of information is estimated to average .50 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number.

This collection of information is authorized under Section 8 of the U.S. Housing Act of 1937 (42 U.S.C. 1437f). The information is used to standardize the information submitted to the receiving Public Housing Agency (PHA) by the initial PHA. In addition, the information is used for monthly billing by the receiving PHA.

Sensitive Information. The information collected on this form is considered sensitive and is protected by the Privacy Act. The Privacy Act requires that these records be maintained with appropriate administrative, technical, and physical safeguards to ensure their security and confidentiality. In addition, these records should be protected against any anticipated threats or hazards to their security or integrity which could result in substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom the information is maintained.

Privacy Act Statement. The Department of Housing and Urban Development (HUD) is authorized to collect the information required on this form by Section 8 of the U.S. Housing Act of 1937 (42 U.S.C. 1437f) and by the Housing and Community Development Act of 1987 (42 U.S.C. 3534(a)). Collection of this information, including SSN and annual income, is mandatory. The information is used to standardize the information submitted to the receiving Public Housing Agency (PHA) by the initial PHA. In addition, the information is used for monthly billing by the receiving PHA. The SSN is used as a unique identifier. HUD may disclose this information to Federal, State and local agencies when relevant to civil, criminal, or regulatory investigations and prosecutions. It will not be otherwise disclosed or released outside of HUD, except as permitted or required by law. Failure to provide any of the information may result in delay or rejection of a family port.

Part I Initial PHA Information and Certification

Instructions: This portion of the form is to be completed by the initial PHA for a family that is moving out of the initial PHA’s jurisdiction under the portability procedures.

1. Headof Household Name

2. Headof Household SocialSecurityNumber

3. Voucher Number (if applicable)

4. Bedroom Size

5.IssuanceDate (mm/dd/yyyy)

6.Expiration Date (mm/dd/yyyy)

7.Dateof LastIncomeExamination (mm/dd/yyyy)

8.

Annual income if new admission (not currently a voucher participant)

$ ___________________________

9.

Date by which initial billing must be received (90 days following the expiration date of the initial PHA voucher) (mm/dd/yyyy)

__________________________

10.

Initial PHA administrative fee rate

$ ____________________________

 

(Note: include proration, if applicable. For example, if the proration factor for the year is 79% and your column B rate is $60, enter $47.4)

11.

80% of initial PHA ongoing administrative fee (line 10 x 0.8)

$ _____________________________

12.

Receiving PHA to which family has been referred: ___________________________________________________.

 

Attachments:

a.A copy of the voucher issued by the initial PHA.

b.The most recent form HUD-50058 and copies of all related verification information for the current form HUD-50058. (Note: This is the latest form HUD-50058 completed for either an applicant, a new admission, an annual reexamination, or an interim redetermination. It is not the form HUD- 50058 that the initial PHA completes to report the portability move-out.)

Certification Statement:

The family is a current program participant or is not a current program participant but is income-eligible in the receiving PHA’s jurisdiction (see line 8 above), and the voucher was issued in accordance with the program regulations. Please issue the family a receiving PHA voucher that does not expire before 30 days from the expiration date indicated in Item 6 (the expiration date on the initial PHA’s voucher) for the appropriate bedroom size (based on the receiving PHA’s policies). I certify that the information contained on Part I of this form and the attached documents provided by my agency are true and correct. My agency will promptly reimburse amounts paid on behalf of the above family within 30 calendar days of receipt of Part II of this form and thereafter ensure that subsequent billing payments are received by your agency no later than the fifth working day of each month. Failure to comply with these payment due dates may result in the transfer of the family's voucher in accordance with program rules and regulations.

Name of Certifying PHA Official __________________________________________

Type Full Name and Address of Initial PHA below

Signature

___________________________________________

 

Initial PHA Contact Name

___________________________________________

 

Phone Number

_________________

Email _______________________

 

Form Submission Date (mm/dd/yyyy) ____________________

 

This form may be reproduced on local office copiers

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form HUD-52665 (08/2016)

 

 

 

Part II-A Receiving PHA Information and Certification

Instructions: The receiving PHA must always complete Part II-A.

1.

Headof Household Name

 

2. Headof Household SocialSecurityNumber

 

 

 

 

 

 

 

3.

VoucherBedroom Size(per receivingPHA’s policies)

4. HAP Contract Number(if applicable)

 

 

 

 

 

 

 

 

5.

Receiving PHA administrative fee rate

$ ____________________________

 

(Note: include proration, if applicable. For example, if the proration factor for the year is 79% and your column B rate is $60, enter $47.4)

Certification Statement:

I certify that the information contained on Part II of this form and, if applicable, the attached form HUD-50058, is true and correct and that my agency will promptly remit any overpayment to your agency.

Name of Certifying PHA Official _____________________________________________

Type full Name and Address of Receiving PHA below

Signature

_____________________________________________

 

Receiving PHA Contact Name

_____________________________________________

 

Phone Number

_________________

Email _______________________

 

Form Submission Date (mm/dd/yyyy) _____________________

Part II-B Family Status, Initial HAP Contract Execution and Billing Changes After HAP Contract Execution

Instructions: for initial billings, Part II-B must be completed by the receiving PHA and received by the initial PHA within 90 days following the expiration date of the initial PHA’s voucher. For changes in the family status or the billing amount, Part II-B must be completed and sent within 10 working days from the effective date of the change. The receiving PHA does not submit the billing form each month unless the monthly amount due changes or both

PHAs agree to a different billing schedule that requires a more frequent billing submittal.

Check all statements below that apply:

1.The above family has failed to submit a request for tenancy approval for an eligible unit within the allotted time period. You may therefore reissue your voucher to another family and, if applicable, modify any records concerning local preference usage and income targeting requirements.

STOP. Do not complete remainder of form.

2.We have executed a HAP contract on behalf of the family and are absorbing the family into our own program effective

_________________(mm/dd/yyyy). You may reissue your voucher to another family. STOP. Do not complete remainder of form.

3.We executed a HAP contract on __________________ (mm/dd/yyyy) with an effective date of ________________ (mm/dd/yyyy) and are billing your agency. The effective date of the family’s annual reexamination will be _________________ (mm/dd/yyyy). A copy of the new form HUD-50058 is attached to this form. No other documentation is required. (Note: Receiving PHAs are required to complete and submit a form HUD-50058 for families moving into their jurisdiction under portability. The receiving PHA may elect to conduct a special recertification of the family to conform the dates of the unit inspection and recertification, but is not required to do so by HUD in order to complete the form HUD- 50058 for a portability move-in.) Complete line 10 below.

4.The HAP amount has changed effective ________________ (mm/dd/yyyy) for the family because of: (Check all applicable items. Complete line 10 below).

annual recertification

interim/special recertification

change in payment standard

the family moved to another unit in the receiving PHA jurisdiction.

other: (specify)

Comments continued on separate page Yes

No

This form may be reproduced on local office copiers

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5.The HAP payments have been abated effective _______________ (mm/dd/yyyy). Please suspend the HAP to owner portion from your payment effective _______________ (mm/dd/yyyy) until further notice. STOP. Do not complete remainder of form.

6.The HAP payments that were abated beginning ________________ (mm/dd/yyyy) have resumed effective ________________ (mm/dd/yyyy). Please resume payment of HAP effective ___________________ (mm/dd/yyyy). (Note: do not complete remainder of form unless line 4 above also apply. In such cases, complete line 10 below.)

7.We will no longer bill your agency because we are terminating the family's participation in the program or the family is voluntarily leaving the program.

Billing arrangement termination effective date:________________________ (mm/dd/yyyy).

Reason for termination: (specify)

STOP. Do not complete remainder of form.

8.We are absorbing the family into our program and terminating the billing arrangement effective: ____________________ (mm/dd/yyyy).

STOP. Do not complete remainder of form.

9.The HAP contract has been terminated effective ___________________ (mm/dd/yyyy) and no new HAP contract has yet been executed on behalf of the family.

The family:

will not be remaining in our jurisdiction and has been referred to your agency.

intends to remain in our jurisdiction. The family’s voucher expires _________________ (mm/dd/yyyy). (Note: submit this form again once

you know the outcome of the family’s search).

STOP. Do not complete remainder of form.

 

10. Billing Information

 

Regular Billing Amount:

 

a. Monthly HAP amount due

_____________________

(line 12s or 12af of form HUD-50058)

 

b. Ongoing admin fee

_____________________

((1) lesser of: Part I, line 11 or Part II, line 5, or (2) amount otherwise agreed upon)

 

c. Total regular monthly billing amount

$ 0.00

_____________________

(sum of lines a and b)

 

Additional Amount Due, If Applicable:

 

d. Prorated HAP to owner from ____________to _____________

_____________________

e. Hard-to-house fee, if applicable

____________________

f. Other (explain)

_____________________

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form HUD-52665 (08/2016)

g. Total additional amount (sum of lines d, e and f)

$ 0.00

____________________

Total Billing Amount:

 

h. Payment Due This Billing Submission (sum of lines c and g)

$ 0.00

_____________________

(After this submission, billing amount is amount recorded on line c, unless otherwise notified by the receiving PHA.)

Comments:

Clear All

 

Print

 

 

 

 

 

 

This form may be reproduced on local office copiers

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form HUD-52665 (08/2016)
Get Hud 52665 PDF Form

Form Characteristics

Fact Description
Purpose The HUD 52665 form facilitates the transfer of Housing Choice Vouchers between Public Housing Agencies (PHAs) as part of the portability process.
Governing Laws This form is authorized under Section 8 of the U.S. Housing Act of 1937, codified at 42 U.S.C. 1437f, and the Housing and Community Development Act of 1987 (42 U.S.C. 3534(a)).
Privacy Protections Information collected on the HUD 52665 is sensitive and protected by the Privacy Act. Agencies must maintain appropriate safeguards to ensure confidentiality.
Submission Requirements PHAs must complete specific portions of the form, provide required attachments, and submit it within defined timeframes, such as 90 days after the initial voucher's expiration.

Guidelines on Utilizing Hud 52665

Completing the HUD 52665 form is a significant step in the process of portability for families moving between different Public Housing Agencies (PHAs). This form standardizes the information exchanged between the initial and receiving PHAs, ensuring a smooth transition for the family involved. Follow these steps to accurately fill out the form and facilitate the portability process.

  1. Part I - Initial PHA Information: Begin by listing the Head of Household's name.
  2. Enter the Head of Household's Social Security Number.
  3. If applicable, include the voucher number.
  4. Indicate the bedroom size needed for the family.
  5. Record the issuance date of the voucher in mm/dd/yyyy format.
  6. Provide the expiration date of the voucher in mm/dd/yyyy format.
  7. Enter the date of the last income examination in mm/dd/yyyy format.
  8. If the family is a new admission, write down the annual income.
  9. Specify the date by which initial billing must be received (90 days following the expiration date).
  10. Include the initial PHA administrative fee rate.
  11. Calculate and provide 80% of the initial PHA ongoing administrative fee.
  12. Identify the receiving PHA to which the family has been referred.
  13. Attach a copy of the voucher issued by the initial PHA and the relevant HUD-50058 forms.
  14. Certify the information provided by filling out the certifying PHA official's name, signature, contact information, and the form submission date.
  1. Part II-A - Receiving PHA Information: Start with the Headof Household's name.
  2. Next, input the Head of Household's Social Security Number.
  3. Record the bedroom size based on the receiving PHA's policies.
  4. Include the HAP Contract Number if applicable.
  5. Provide the receiving PHA administrative fee rate.
  6. Certify the information by completing the certifying PHA official's name, signature, and contact information.
  1. Part II-B - Family Status, HAP Contract Execution, and Billing Changes: Mark any relevant statements regarding family status or billing changes.
  2. For applicable options, fill out the date, reason for changes, and any additional comments required.
  3. Calculate the regular monthly billing amount by providing the monthly HAP amount due and the ongoing admin fee.
  4. If there are additional amounts due, detail them and calculate the total billing amount.

After completing all necessary sections, double-check the information to ensure accuracy before submitting the form to the appropriate PHAs. Timely submission and correct information are crucial in facilitating the family's transition and compliance with housing regulations.

What You Should Know About This Form

What is the HUD 52665 form used for?

The HUD 52665 form, known as Family Portability Information, is used within the Housing Choice Voucher Program. It helps one Public Housing Agency (PHA) communicate essential information about a family that is moving to another PHA's jurisdiction. This includes billing information, family details, and administrative data necessary for standardizing information transfer between agencies.

Who needs to fill out the HUD 52665 form?

The form is filled out by both the initial PHA and the receiving PHA. The initial PHA completes part of the form when a family decides to move under portability procedures. After that, the receiving PHA must complete another part to ensure proper billing and family status tracking.

Is the information provided on the HUD 52665 form confidential?

Yes, the information on the HUD 52665 form is considered sensitive and is protected under the Privacy Act. This means that appropriate measures are in place to maintain the confidentiality and security of the information provided, such as safeguarding against unauthorized access and ensuring proper record maintenance.

What happens if a family does not provide information required on the form?

Failure to provide required information can lead to delays or even the rejection of the family's portability request. It is important for families to complete the form accurately and thoroughly to prevent any issues with their housing assistance.

How is the information on the HUD 52665 form used?

The data collected is utilized to standardize information between PHAs, assist with billing processes, and ensure that the family's eligibility for assistance is verified. Information such as social security numbers and annual income is collected to ensure compliance with housing assistance regulations.

What is the process if a family's situation changes after submitting the form?

If there are changes in the family's status, the receiving PHA must update the HUD 52665 form. This could include information about changes in income, family composition, or the housing assistance payment (HAP) amounts. Any updates should be made within designated timeframes to keep records accurate.

Can the HUD 52665 form be reproduced or copied?

Yes, the HUD 52665 form can be reproduced. Agencies are encouraged to make copies for their local offices as needed to facilitate the portability process for families moving between jurisdictions.

What should families know about the certification statement on the form?

The certification statement ensures that the initial PHA verifies the family's eligibility and compliance with program regulations. By signing it, the official affirms that the provided information is true and accurate, which is vital for the integrity of the assistance process.

Are there any attachments required with the HUD 52665 form?

Yes, specific attachments are necessary. This includes a copy of the voucher issued by the initial PHA and the most recent form HUD-50058, along with any related verification documents. These attachments help maintain thorough and complete records during the portability process.

What should a PHA do if they need to change the billing arrangement for a family?

If billing arrangements need to change, the receiving PHA must indicate the new billing information on part II-B of the HUD 52665 form. This ensures that all involved agencies remain informed and updated on the family's circumstances and any adjustments in payment amounts.

Common mistakes

Completing the HUD 52665 form correctly is essential for ensuring a smooth process for families moving under the Housing Choice Voucher Program. However, many individuals make common mistakes that can delay approval or result in rejections. Understanding these errors can help streamline the submission process.

One common mistake is failing to include the complete head of household's name. This field must be accurate and thorough. Omitting a middle initial or using an informal name can cause confusion and lead to processing delays. Adequate emphasis should be placed on verifying this detail against official documents.

Another frequent error is the misentry of the Social Security Number (SSN). The SSN is critical as it serves as a unique identifier for the applicant. Even minor mistakes, such as transposed digits, can prevent proper identification and lead to significant processing hurdles.

Many submitters neglect to specify the voucher number, if applicable. This number helps link the application to previously established files. Without it, the receiving Public Housing Agency may not be able to locate relevant records, increasing the likelihood of delays.

Additionally, inaccuracies in income figures are common. Families often underestimate or overestimate their annual income, which can lead to eligibility issues. Ensuring that this amount is verified and calculated correctly will facilitate a smoother review process.

Some applicant representatives fail to notice that the expiration date and the issuance date must be entered in the correct format. Using an incorrect format can create complications in understanding the timeline of benefits and responsibilities under the voucher program.

Submitting incomplete documentation is another significant mistake. The application requires attachments, such as a copy of the issued voucher and the most recent HUD-50058 form. Incomplete submissions often result in delays or outright rejection, as the receiving PHA relies on this documentation for thorough evaluation.

Sometimes, applicants overlook the requirement for a certification statement by the initial Public Housing Agency official. This affirmation is essential to confirm the accuracy of the information submitted and indicates accountability, which is a vital component in this process.

A common oversight involves failings in the billing information section. Errors in calculating the ongoing administrative fee or mistakenly omitting details can lead to unexpected complications in funding and assistance for the applicant. Every field in this section must be clearly and accurately filled out to avoid issues.

Many applicants also forget to check for changes in family status or billing amounts. These updates need to be submitted promptly to ensure that the information is current and that billing reflects any changes in eligibility or circumstances.

Lastly, applicants sometimes fail to adhere to the specified deadlines for submissions. The regulations dictate that certain forms must be completed and sent within specific timeframes. Missing these deadlines can undermine the entire process, resulting in loss of assistance or difficulty in transferring the voucher.

By being mindful of these frequent mistakes, individuals can significantly enhance their chances of a smooth transition in the housing process. Accuracy and attention to detail are crucial in every aspect of filling out the HUD 52665 form.

Documents used along the form

The HUD 52665 form is an essential document that facilitates the portability process in the Housing Choice Voucher Program. Along with this form, several other forms and documents may be required to ensure a seamless transition for families moving under this program. Below is a list of common documents that are often utilized in conjunction with the HUD 52665.

  • Form HUD-50058: This form is used to collect information about a family’s demographics, income, and other relevant details. It provides a comprehensive snapshot required for both administering vouchers and assessing eligibility.
  • Form HUD-50059: This form is utilized to report changes in family composition or income. It ensures that any updates are accurately reflected in the program’s records.
  • Form HUD-524: This document is for reporting Housing Assistance Payment (HAP) contracts. It plays a critical role in tracking agreements between the receiving Public Housing Agency (PHA) and the property owner.
  • Tenant Payment Agreement: This agreement outlines the responsibilities of the tenant regarding payments of additional costs not covered by the voucher. It helps in clarifying expectations between the tenant and the landlord.
  • Evidence of Income: This may include pay stubs, tax returns, or other documentation demonstrating the household’s income. It is essential for determining eligibility and assistance levels.
  • Verification of Social Security Number (SSN): Documentation that confirms the SSNs for all household members must be provided to ensure proper processing and compliance with federal regulations.
  • Lease Agreement: A copy of the lease between the family and the landlord must be submitted to confirm that the family has secured housing within the receiving PHA's jurisdiction.
  • Portability Voucher: This document is issued by the initial PHA and allows families to move across different jurisdictions while retaining their housing assistance benefits.
  • Contact Information for the Initial PHA: Including this helps facilitate communication between the receiving PHA and the initial PHA, especially regarding billing and compliance matters.
  • Request for Tenancy Approval (RTA): When families identify a potential rental unit, this form must be completed to seek approval from the receiving PHA, ensuring the unit meets program standards.

These documents work together with the HUD 52665 form to create a complete and accurate record necessary for the portability process. By ensuring that all required information is efficiently gathered and maintained, families can transition smoothly into their new living arrangements.

Similar forms

The HUD 52665 form is crucial for the portability process of families participating in the Housing Choice Voucher Program. Several other documents share a similar function, helping in the management of housing assistance. Here are eight documents that are comparable to the HUD 52665 form, along with ways in which they are similar:

  • Form HUD-50058: Like the HUD 52665, this form records the household composition and income of families in the Housing Choice Voucher Program. It helps in standardized reporting to public housing authorities.
  • Form HUD-52641: This document serves as a request for a voucher and outlines the eligibility criteria for the program, similar to the HUD 52665’s focus on eligibility during family portability.
  • Form HUD-50059: Used for reporting changes to family information and income, this form functions similarly to the HUD 52665 by ensuring that changes are documented accurately for billing and assistance determinations.
  • Form HUD-90010: This pre-application form for various HUD programs gathers information necessary for assessing housing needs, much like how the HUD 52665 collects initial family details during the portability process.
  • Form HUD-8609: This document is utilized to allocate low-income housing tax credits. It captures essential information about housing projects, akin to the HUD 52665’s aim of documenting housing assistance for families.
  • Form HUD-2760: A key form in the project-based voucher program, it similarly helps track families' eligibility and their housing status, just as the HUD 52665 does for those transferring to different jurisdictions.
  • Form HUD-50057: This form captures specific financial assistance data for families, overlapping with the HUD 52665’s role of documenting income and housing information for effective billing.
  • Form HUD-92006: This is the "Supplemental Claim for Rental Assistance" form. It is completed by housing agencies and shares the intention of ensuring consistent treatment of rental assistance calculations, just like the HUD 52665 facilitates communication among housing agencies.

Each of these forms plays a vital role in the administration of housing assistance, sharing similarities in focus on eligibility, income reporting, and ensuring families receive the support they need.

Dos and Don'ts

When filling out the HUD 52665 form, there are important do’s and don'ts to ensure accuracy and compliance.

  • Do make sure all required fields are filled out completely. Incomplete forms can lead to delays in processing.
  • Do double-check names and identification numbers for accuracy. Mistakes in these areas can cause significant issues later on.
  • Do read the instructions thoroughly before starting. Understanding the requirements can help avoid common pitfalls.
  • Do keep copies of all documents submitted. Having backup records can be helpful if any questions arise.
  • Don't provide sensitive information unless absolutely necessary. Protect your privacy by sharing only what is required.
  • Don't rush through the form. Taking your time ensures that all details are accurate, which can save time down the road.
  • Don't submit the form after the deadline. Timeliness is crucial, as late submissions can result in rejections.
  • Don't hesitate to seek help if you have questions. Contacting a knowledgeable professional can clarify uncertainties you may have.

Misconceptions

The HUD 52665 form is essential for families participating in the Housing Choice Voucher Program when they move out of their initial Public Housing Agency (PHA) jurisdiction. However, several misconceptions surround this form that can lead to confusion. Below are some common myths about the HUD 52665 form, accompanied by clarifications to provide a clearer understanding.

  • Misconception 1: Completing the form is optional for families.

    • This is not true. Filling out the HUD 52665 form is a mandatory process for families who wish to port their vouchers. Without this form, the portability move can be delayed or rejected.

  • Misconception 2: Only the receiving PHA needs to fill out the form.

    • In reality, both the initial and receiving PHAs have specified sections to complete. The initial PHA is responsible for part one of the form, which contains vital information about the household and voucher, while the receiving PHA must fill out part two.

  • Misconception 3: Privacy concerns related to the form are exaggerated.

    • On the contrary, the information collected on the HUD 52665 form is considered sensitive. It is protected under the Privacy Act, which mandates safeguards to ensure security and confidentiality. Appropriately handling this data is crucial to protecting families' personal information.

  • Misconception 4: Families can expect a quick process after submitting the form.

    • The timeline for processing the HUD 52665 can be longer than anticipated. Families must ensure that all parts of the form are filled out correctly and that all required documents, such as copies of the voucher, are attached. Missing information can lead to delays.

  • Misconception 5: All PHAs follow the same regulations for the HUD 52665 form.

    • This is a misunderstanding. While the HUD 52665 form is standardized, each PHAs might have its own policies and procedures regarding the portability process. It is essential for families to be aware of their respective PHA’s requirements, which may differ from those of another agency.

Key takeaways

Key Takeaways for Filling Out and Using the HUD 52665 Form:

  • Ensure all information is complete and accurate. Missing details could lead to delays or rejection of your family's portability request.
  • Submit the form within the specified timeframes, especially regarding billing submissions and changes in family status. Adhering to deadlines is crucial.
  • Protect sensitive information included in the form by adhering to the Privacy Act. This ensures security and confidentiality for all parties involved.
  • Attach the necessary documentation as outlined in the form, including copies of the voucher and relevant HUD-50058 forms. Missing attachments can impede the process.

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